Periodontal plastic surgery: the envelope technique applied to correct lingual gingival defect

Vol. 11 – Number 44 – 2020 IMPLANT DENTAL NOTEBOOK Case report Page 52-57 Periodontal plastic surgery: the envelope technique applied to correct lingual gingival defect Venâncio Corrêa de Oliveira Neto¹ Gabriel Garcia Bardales¹ Gecimara de Souza Lopes¹ Marcelo Diniz Carvalho² ABSTRACT A 39-year-old, healthy, non-smoker patient sought dental care reporting hypersensitivity and difficulty of cleaning the area where an included tooth 35 have been extracted. A CT scan was requested and the images showed considerable bone loss in the mesial of the 36 and distal of the 34. After periodontal examination, the patient was diagnosed with gingival disease induced by biofilm, as it did not have a probing depth above 3mm at the location. However, there was a recession of 3mm in the mesial of 36 and of 2mm in the distal and mesial sites of 34, both on the lingual surface of the teeth. Thus, the proposed treatment was for a conjunctive graft, with  he donor palatal connective tissue as the donor area. The technique chosen was the envelope, in which sulcular incisions were made, creating a subperiosteal tunnel, without rupture of the papilla. The graft was placed in this subperiosteal tunnel and fixed by sutures. Two sutures were also performed supported on the contact point, promoting coronary traction of the entire flap. The technique eliminates the need of a vertical incision, protecting the papilla height, and optimizing vascularization. The result obtained so far has shown that the recession has been covered and also that dentinal sensitivity was eliminated. Descriptors: Periodontics, gingival recession, plastic surgery. ¹ Graduated in Dentistry – UEA. ² Prof. Assistant to the Dentistry Course – UEA. Esp., Me. And PhD in Periodontics – UNICAMP.